The Influencing Factors Of Total Thyroidectomy Combined With Parathyroid Autotransplantation For The Treatment Of Papillary Thyroid Cancer Complicated With Hypothyroidism

Background Thyroid cancer is a common endocrine malignant tumor in clinic.In recent years,its incidence rate has continued to rise in the past decade.Thyroid surgery has become the treatment of most thyroid cancer,but hypoparathyroidism is the most common and serious complication.In order to prevent this complication,many studies have shown that parathyroid autotransplantation can improve this symptom.With the development of total thyroidectomy combined with parathyroid autotransplantation,relevant influencing factors still need to be explored.Objective To explore the influencing factors of hypoparathyroidism secondary to parathyroid autotransplantation after total thyroidectomy combined with central lymph node dissection for papillary thyroid carcinoma,and to provide reference for predicting postoperative hypoparathyroidism.Methods A total of 241 patients who underwent total thyroidectomy combined with parathyroid autotransplantation from October 2019 to October 2021 in the Department of Thyroid and Breast Surgery of the First Clinical Medical College of Three Gorges University were retrospectively analyzed.All patients underwent the first operation and were completed by the same group of surgeons.After the operation,all patients were diagnosed as papillary thyroid carcinoma by pathology,and their parathyroid hormone and blood calcium were collected within 24 hours,According to the reference value standard,the patients were divided into normal parathyroid function group and hypothyroid function group,and the parathyroid hormone and blood calcium of all patients were rechecked 6 months after operation,and the hypothyroid function group after operation was divided into temporary hypothyroid function group and permanent hypothyroid function group.The study data were analyzed with SPSS26.0 statistical software,and the differences of clinical data between each group were compared with single factor and multiple factor statistical methods to find the influencing factors of hypoparathyroidism and PHOP.Results A total of 241 patients were included in this study,including 66 cases(27.39%)in the normal parathyroid group,175 cases(72.61%)in the hypothyroid group,156 cases(64.73%)in the temporary hypothyroid group,and 19 cases(7.88%)in the permanent hypothyroid group;Univariate analysis: the incidence of postoperative hypothyroidism in patients with tumor invasion of the trachea was significantly higher than that in patients without invasion of the trachea(85.71% vs 69.27%,P=0.021);The incidence of hypoparathyroidism in patients with tumor invasion outside the capsule was higher than that in patients without invasion outside the capsule(82.18% vs 66.19%,P=0.009),and the difference was statistically significant;The incidence of postoperative hypothyroidism in patients with Hashimoto’s thyroiditis was significantly higher than that in patients without Hashimoto’s thyroiditis(83.53% vs 66.67%,P=0.004);The incidence of hypoparathyroidism in patients who used nano-carbon during operation was significantly lower than that in patients who did not use nano-carbon(67.95% vs 81.18%,P=0.028).Multivariate analysis:Intraoperative use of nano-carbon(regression coefficient=-1.094,OR=0.335,95% CI:0.160-0.701)was an independent protective factor for postoperative hypoparathyroidism,accompanied by Hashimoto’s thyroiditis(regression coefficient=0.913,OR=2.492,95% CI:1.180-5.263);With tumor invading trachea(regression coefficient=1.358,OR=3.888,95% CI:1.528 ～ 9.893);With tumor invasion outside the capsule(regression coefficient=1.022,OR=2.779,95% CI: 1.394 ～ 5.541),it is an independent risk factor for postoperative hypoparathyroidism.Conclusion The use of nano carbon during surgery can carefully identify and remove black stained lymph tissue,prevent parathyroid damage,and effectively reduce the incidence of decreased parathyroid function;Accompanying Hashimoto’s thyroiditis can make envelope dissection challenging and difficult to identify parathyroid glands.Tumor invasion of the trachea and extracapsular invasion can increase the difficulty of preserving parathyroid glands in situ during surgery,increasing the incidence of hypoparathyroidism.